Updated: May 13, 2020
Along with finding a care provider that is the perfect fit for you, it is important to research the facility where you plan to give birth. In general, there are three options for birthing locations: hospital labor ward (labor and delivery), a free standing birth center, or at home. Are you ready to learn more about these options and determine what is right for you?
Let's talk more about hospital births!
The vast majority of babies born in the United States are born inside of a hospital. Depending on region, health history, insurance coverage, and other factors, the majority of families will go to a hospital to give birth. Hospitals can offer a variety of models of care, and many employ both Obstetricians and Certified Nurse Midwives. Some facilities offer "bare bones" births with the typical medical approach, while others strive to replicate a birth center feel with labor tubs and large birthing suites. One reason many families feel comfortable at a hospital is the fact that the OR suite is right down the hall in case of an emergency (for other families this is exactly what makes them uncomfortable in the hospital). Looking into your facility's Cesarean rate can help you develop questions for the staff and decide if the hospital you're considering is the right fit for you. For some families, a high-risk hospital with upper level NICU teams in a necessity. For other families, a smaller unit with less staff is important. Get to know your facility, how the nurses approach birth, and the overall facility philosopphy regarding birth.
The vast majority of babies born in the United States are born inside of a hospital. Depending on region, health history, insurance coverage, and other factors, the majority of families will go to a hospital to give birth. Hospitals can offer a variety of models of care, and many employ both Obstetricians and Certified Nurse Midwives. Some facilities offer "bare bones" births with the typical medical approach, while others strive to replicate a birth center feel with labor tubs and large birthing suites. One reason many families feel comfortable at a hospital is the fact that the OR suite is right down the hall in case of an emergency (for other families this is exactly what makes them uncomfortable in the hospital). Looking into your facility's Cesarean rate can help you develop questions for the staff and decide if the hospital you're considering is the right fit for you. For some families, a high-risk hospital with upper level NICU teams in a necessity. For other families, a smaller unit with less staff is important. Get to know your facility, how the nurses approach birth, and the overall facility philosophy regarding birth.
Benefits of Hospital Birth
If you are high risk you can still have the compassionate care of a CNM while also working with an OB
Epidurals, other medications and interventions, and cesareans are (almost) immediately available if needed or desired
Postpartum care and IBCLC is usually readily available to provide support
Risks of a Hospital Birth
Higher likelihood of unwanted or unnecessary interventions / more pressure for frequent cervical checks, monitoring, and other "hands on" care that may not be desired
Care providers often work in large practices which can make continuity of care and knowing your provider well a challenge
You may not feel relaxed and comfortable in this environment with lots of machines, strangers, and a possibly uncomfortable room (for other people, the hospital may provide the safety/comfort factor desired)
Chances of nosocomial (hospital acquired infections) increases
Now let's look at the homebirth option!
Only about less than 2% of births happen outside of the hospital in the United States, and of these, less occur at hime (with the rest occurring in birth centers). However, homebirth is generally considered a safe option with a low risk pregnancy and a trained midwife. Homebirth midwives can be CNMs (Certified Nurse Midwives) or CPM (Certified Professional Midwives), both trained in managing physioloigical birth and recognizing emergencies and the need for transfer. Sometimes, CNMs might have hospital privileges which can be really comforting if you end up needing to transfer to the hospital as you will maintain continuity of care. As always, it is important to interview homebirth midwives and find one who's care model fits you and your family.
We will save the nuances of the homebirth conversation for another post, but let's dive into the pros and cons of homebirth! Benefits of Homebirth
Birthing in the comfort of your own home allows you to relax. A relaxed, safe feeling environment is more supportive than an environment that causes stress in the mother
Low risk of hospital acquired infections / baby is colonized with families microbiome from the start
Homebirth midwives tend to practice alone or in small groups increasing continuity of care and personal relationships
No need to rush to the hospital when labor begins and worry about going too soon or too late
After birth you can sit back into your own bed in your own home and bond with your family without rules and unwelcome interruptions
Midwives will come check on you in your home, no need to leave the house for postpartum care
Midwives typically carry emergency support gear including oxygen and other emergency equipment to ensure safe transfer if necessary
Risks of Homebirth
In a rare emergency, getting to emergency medical services may take longer
A midwife practicing alone could have two babies coming at the same time, make sure your midwife has a good back up system
Some midwives do not have hospital privileges so, in case of a transfer, your midwife would step into a doula role and no longer be in charge of your care
Different states have different policies on what kinds of medications midwives can carry to births, and this might differ based on licensing (CNM vs CPM), so you need to get clear answers on what your midwife can and cannot do
There is no Lactation Consultant on staff to provide breastfeeding support so you may need to have one you can contact for support.
Costs are often out of pocket although some insurance companies may offer partial reimbursements
Disclaimer: I think it is important to note that the vast majority of homebirth transfers are for non-emergent situations, and most emergencies can be identified early enough for safe transfer and safe delivery.
Now, you might be thinking, "Jaimie, isn't there some kind of in between? I don't feel comfortable birthing at home but don't want to be anywhere near a hospital" A birth center might just be the perfect location for you! You will have to tour your local birth center to see exactly what they offer, but below we explore the general benefits and risks of a birth center facility:
Benefits of Birth Center:
To save space and time, the majority of homebirth benefits apply to birth centers, except for the fact you're not actually at home
You will not have to stay for days like you would after a hospital birth, you will be released home usually within 8-12 hours (then again for some people this may be a "con")
Birth centers often have great relationships with EMS and the transfer hospital facility to allow for seamless transfers
Risks of Birth Center :
Again, I'm going to refer you to the Risks of Homebirth section to save time and energy
You don't get to settle back into your own space right away
You may have to leave the home for postpartum checks
Keep in mind that your birthing location may be limited based off where your chosen provider works. This means that when you are looking for your perfect provider, it is imperative to be aware of where you would like to give birth and where your obstetrician or midwife catches babies. Remember to ask questions about cesarean and induction rates, how many births your facility (or midwife) supports on an average month, how they handle emergencies, and how they respond to any other situations that you may have concerns about.
The decision of where to give birth and who oversees your pregnancy care are two of the biggest factors in your overall birth outcome and experience. Make sure that you and your partner talk about all of the options together to determine what is best for your family. Consider how you would feel in a variety of locations and situations, talk to midwives and OBs and other mothers who have utilized the options you're considering. If you want to learn more about how to choose a midwife or OB jump on over to this informative post that helps answer your questions!
Jaimie Zaki, owner of Little Bear Services, LLC is a Birth Photographer, Labor Doula, & IBCLC serving families in South Jersey and Central New Jersey. Mother of three, military wife, and lover of coffee, Jaimie enthusiastically supports hospital and home births in Burlington County, Camden County, Mercer County, Atlantic County, Ocean County in New Jersey. If you reside outside of this service area, there are online courses and virtual support packages available! Jaimie is excited to serve your family! Learn more about Jaimie and the services she offers!
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